Sulfonylureas should be avoided in which situation?

• A. Pregnancy and lactation
• B. Elderly
• C. Renal impairment
• D. None of the above

Answer: (A)

Sulfonylureas stimulate the pancreas to release insulin, but they can cross the placenta and reach the fetus. That exposes the developing baby to the drug, which can cause fetal and neonatal hypoglycemia after birth and potential other risks. Similarly, during breastfeeding, the drug and its metabolites can pass into breast milk and may induce hypoglycemia in the nursing infant. For these safety reasons, sulfonylureas are avoided in pregnancy and lactation, with insulin being the preferred option to control blood glucose in these states. In contrast, while elderly patients or those with renal impairment require careful monitoring and sometimes dose adjustments due to higher hypoglycemia risk, these conditions do not by themselves mandate avoiding sulfonylureas.